PROJECT SUMMARY/ABSTRACT This career development award will provide Dr. Lisa VanWagner the opportunity to develop as an independent researcher translating research into clinical practice using qualitative research methods and implementation science principles to improve cardiovascular outcomes among patients with liver disease. Dr. VanWagner will use this award to enhance her existing extensive skills in clinical epidemiology with new skills and knowledge in the application of user-centered and learning collaborative approaches and implementation science principles to optimize future uptake and adherence by multidisciplinary treatment teams of a liver transplant- specific cardiovascular disease Guideline and Care Pathway. These skills will allow her to translate epidemiologic findings into clinical practice in order to improve cardiovascular outcomes in patients with liver disease. She will achieve these career goals through a career development plan that consists of formal coursework, intensive mentorship, experiential training, and patient-oriented research. Her primary mentor is Dr. Donald Lloyd-Jones, an expert in cardiovascular disease outcomes and prevention with multiple active NIH grants and an outstanding record of mentoring. Her co-mentors include experts in healthcare quality and safety (Dr. Jane Holl), and qualitative research methods (Dr. Elisa Gordon), both with outstanding track records in training independent investigators. This will be accomplished at Northwestern University. Northwestern provides Dr. VanWagner with 1) dedicated support from the Division of Gasteroenterology and Hepatology, Department of Medicine; 2) her multidisciplinary team of mentors; 3) numerous courses and professional interactions relevant to her career development, including the Northwestern University Clinical and Translational Sciences Institute and the Institute for Public Health and Medicine; 4) research infrastructure that includes an institutional electronic data collection program and biostatistical support; and 5) extensive clinical infrastructure. The overall purpose of the research strategy is to create, implement, and test the feasibility of a Cardiovascular Disease Quality Improvement in Liver Transplantation (CVD QUILT) Care Pathway that includes a liver transplant-specific cardiovascular disease guideline, using a multidisciplinary treatment team approach. The findings of this study will target reducing cardiovascular disease in a high-risk population: patients with liver disease who have received life-saving organ transplants from scarce donated organs. The study will be conducted at a single academic hospital. Specific Aim One will create liver transplant-specific cardiovascular disease clinical practice guidelins. Specific Aim Two will use qualitative research methods to assess and address barriers and facilitators to the implementation and adherence to the Guideline by design and development of the CVD QUILT Care Pathway. Specific Aim Three will test the feasibility of implementation of CVD QUILT to improve cardiovascular disease care in liver transplant recipients.